Optimal treatment for relapsing ovarian cancer

The cure rate for women with ovarian cancer has not significantly changed over the past 10 years. However, overall survival from relapsed disease has shown improvement despite a lack of increase in progression-free survival. There are now many therapeutic options for women with relapsed disease. Treatment strategies are still led by the description of relapse as platinum sensitive or resistant/refractory using somewhat arbitrary definitions. Now that there is increased choice of treatment, these definitions are becoming outdated. The current challenges in managing relapsed ovarian cancer are defining the optimal sequence of available drugs as well as timing of treatment for relapsed disease. The abundance of novel therapeutics and molecular targets has compounded the difficulty in identifying best practice but has undoubtedly provided an opportunity to improve the treatment we can offer our patients. The lack of validated biomarkers to inform patient selection remains an area of real need in ovarian cancer. Efforts should be made to increase the use of biomarkers in trial design to aid rational targeting of new therapies. In this review we discuss current practice in the treatment of relapsed ovarian cancer and highlight the most promising emerging therapeutics and strategies being employed in randomized clinical trials.